Editorial 1 : The not young
Introduction: Much of the public discourse on Indian demographics focuses on the youth bulge and the challenge of utilising the “demographic dividend”. What does not get equal attention is that India is also ageing, given rising life expectancy, which has implications for social security for older persons.
The estimates of older population in India
- It is estimated that the proportion of older persons in the total population will increase from 8.6 per cent in 2011 to 20.8 per cent in 2050.
- Inter-state variations are reflected in the age structure of the population, including the ageing experience.
- Most states in the southern region and select northern states such as Himachal Pradesh and Punjab reported a higher share of elderly population than the national average in 2021.
- This gap is expected to widen by 2036.
Rapid Ageing in East and South Asia
- Accelerated Ageing: East and South Asian societies are ageing much faster than Western countries, with changes occurring in 20-30 years that took over a century in the West.
- Challenges of Rapid Ageing: Middle and low-middle-income countries in the region face particular challenges due to inadequate social protection for the elderly, including pensions, healthcare, and social care services.
- Shifting Family Structures: The rise of nuclear families is further complicating the care for the elderly in the region.
- Policy Responses: Some East Asian countries have proactively addressed the issue by:
- Integrating health and social care services.
- Investing in various insurance schemes.
- Strengthening community-level care institutions.
India’s Challenges in Addressing the Needs of Older Persons
- Low Visibility of Older Persons’ Needs: The needs of older persons in India do not receive sufficient attention in policymaking compared to other countries.
- Lack of Universal Social Protection: Unlike many East and Southeast Asian countries, India lacks a universal public pension scheme, health insurance, or social care system.
- Limited Targeted Programs: Existing health insurance and social welfare schemes primarily focus on older persons below the poverty line.
- Inequalities in Access to Services: Data indicates disparities in the availability, accessibility, affordability, and acceptability of services for older persons.
- Understanding Older Persons’ Needs: A deeper understanding of older persons' needs from their perspective is crucial.
- Assessing Service Provision: An evaluation of the current social protection, insurance, and healthcare infrastructure is necessary to address these needs.
- Defining the Care Ecosystem: Given the fragmented nature of care services, a comprehensive framework for care delivery is essential.
- Policy Planning Guide: A roadmap for policy development based on the identified needs and care ecosystem is required.
Assessment of condition of older population in India
- According to the Longitudinal Ageing Survey in India (LASI), those above 60 years suffer from multiple morbidities due to non-communicable diseases that include diabetes, hypertension and cardiovascular conditions.
- The survey highlights the variations in the social determinants of the health and well-being of older persons.
- Geographical location, class, caste and gender, work and pensions are important determinants for perceived quality of life.
- A large proportion of older persons, especially those who continue to work and that too in the unorganised sector, are ineligible for pension or other forms of income support.
- The Helpage India Report 2024, ‘Ageing in India: Exploring Preparedness and Response to Care Challenges’, carried out across 10 states and 20 cities, highlights the gaps in access to financial security, health and social care.
- The cross-sectional survey covered Tier I and Tier II cities.
- Its findings highlight the poor coverage of social pensions, which were largely skewed to the middle classes in government service.
- As a result, older persons reportedly felt financially insecure and were dependent on their family members for support.
The medical and geriatric care to the older population
- Access to government health insurance like the Ayushman Bharat Programme is seen as being limited to those below the poverty line.
- Other government insurance programmes like the Central Government Health Scheme (CGHS) or the Employment State Insurance Scheme (ESIS) cover only government employees and those in the organised sector.
- Older persons face difficulties in claiming insurance due to long processing times, claim deductions and rejections.
- Both the LASI survey and the Helpage India Report highlight the burden of multiple morbidities due to one or more Non-Communicable Diseases (NCDs).
- As the disease burden increases with age, the ability to manage activities of daily living reduces.
- Middle-class families are generally able to afford hired domestic help for elderly care, including nursing care.
- Institutional support outside the realm of family and home-based care, in the form of retirement communities and long-term and end-of-life care, is poorly developed in India in the public, private and non-profit sectors.
- The upper-middle class and the rich are able to access the newly emerging retirement communities that provide a range of services for health and social care.
- The problem is acute for the lower-middle class and the urban and rural poor.
Conclusion: Public policy must unpackage the multiple axes of inequalities in access to financial security, health and social care of older persons. As India becomes an ageing society there are significant gaps in access to pensions, health services and social care for older persons that need to be addressed. Even as the country seeks to encash the “demographic dividend” it must pay attention to healthy ageing.
Editorial 2 : Tightrope in the wind
Introduction: The joint statement at the end of the meeting of the Quad foreign ministers — the Quadrilateral Security Dialogue comprising the US, Australia, Japan and India — assumes added significance in the current moment.
The diplomatic tightrope for India since Ukraine crisis
- Ever since Russia’s invasion of Ukraine over two years ago, Delhi has had to walk, often against the wind, a diplomatic tightrope.
- The sharpening differences between the West and Russia-China and within Europe and the US, coupled with the uncertainty around what the results of the American presidential election might mean for European security, and the hard lines being drawn currently, make this balancing act all the more difficult.
The recent Quad summit points out for resisting unipolarity in Asia
- The Quad statement must be read against the background of an increasingly aggressive China — in the Indo-Pacific as well as along the Line of Actual Control with India.
- India’s endorsement of “a free and open Indo-Pacific, vowing to work towards a region where no country dominates others and each state is free from coercion in all its forms”, comes as no surprise.
- The forum is also a way for its members to share technologies and develop common strategies for the region.
India Balances Russia Ties with Western Concerns on Ukraine
- The statement also expressed “deepest concern over the war raging in Ukraine including its terrible and tragic humanitarian consequences. We reiterate the need for a comprehensive, just, and lasting peace in line with international law, consistent with the purposes and principles of the UN Charter, including respect for sovereignty and territorial integrity”.
- The reference to “sovereignty and territorial integrity” is for India a way to assuage concerns about PM Modi’s Moscow visit expressed by Ukraine President Volodymyr Zelenskyy and US officials.
- External Affairs Minister S Jaishankar spoke of his long association with the grouping as a way to put a face and story to Delhi’s commitment to the Quad.
- India is also set to send a high-level delegation to Kyiv in August.
The balancing henceforth is going to be more challenging for India
- The fact is that New Delhi’s primary concern is to secure the interests of its citizens.
- But its backing “territorial integrity” is not merely paying lip service: It is a matter of principle on the boundaries with Pakistan and China as much as it is in Europe.
- Its commitment to peace, too, has been a long-standing position as has the principle of independence in foreign policy.
- Jaishankar told reporters that India’s issues with China must be solved bilaterally, without third parties getting involved.
- But despite these anchors, “multi-alignment” will only get more challenging.
- Donald Trump’s return to the White House could mean a very different scenario in Europe and perhaps a greater focus on containing China.
Conclusion: India’s Quad statement is seen as its course correction for the bad picture of ‘bearhugging’ Russian President amid attack on Ukrainian soil. India clearly sends the signal that it does not indorse Russia’s side. For now, however, going ahead, the foreign office must continue to be nimble and responsive, as it has been so far.